Renal transplantation
Outcome
Basiliximab or Antithymocyte Globulin for Induction Therapy in Kidney Transplantation: A Meta-analysis

https://doi.org/10.1016/j.transproceed.2010.02.088Get rights and content

Abstract

Objective

To compare efficacy and safety of basiliximab versus antithymocyte globulin (ATG) for induction therapy in kidney transplantation.

Methods

A literature search of the MEDLINE, EMBASE, CBMdisc, and Cochrane databases was used to identify randomized controlled trials that compared basiliximab and ATG for induction therapy in kidney transplantation. Inclusion criteria comprised: prospective randomized controlled clinical trials, follow-up time ≥12 months, randomized comparisons of ATG versus basiliximab as induction therapy in kidney transplantation. Meta-analytical techniques were applied to identify differences in outcomes between the two agents.

Results

A total of six studies involving 853 patients were identified. No differences between ATG and basiliximab were seen in terms of biopsy-proven rejection (relative risk [RR] 1.15, 95% confidence interval [CI] 0.88–1.52, P = .31), delayed graft function (RR 1.02, 95% CI 0.69–1.51, P = .93), graft loss (RR 1.15, 95% CI 0.73–1.80, P = .55), and patient death (RR 1.22, 95% CI 0.65–2.30, P = .54). But basiliximab had a lower incidence of infection (RR 0.87, 95% CI 0.78–0.97, P = .02) and neoplasm (RR 0.29, 95% CI 0.09–0.97, P = .04).

Conclusions

Basiliximab is as effective as ATG for induction therapy in kidney transplantation, whereas basiliximab has a lower incidence of infection. Basiliximab may be a safer and preferable option for induction therapy in kidney transplantation.

Section snippets

Search Strategy

On August 16, 2009, PubMed/MEDLINE (1966 to August 2009), Cochrane Collaboration's Central Register of Controlled Trials (Issue 3, 2009), EMBASE.com (1966 to August 2009), and the China Biological Medicine Database (CBMdisc; 1978 to August 2009) were searched, using the validated Cochrane highly sensitive search strategy for RCTs. The search terms employed were “simulect,” “basiliximab,” “interleukin 2 receptor antibody,” “antithymocyte globulin,” “ATG,” “kidney transplantation,” and “renal

Descriptions of Studies

By using the search key terms listed earlier, 264 articles were identified. Eighteen articles were retrieved for full-text assessment after titles and abstracts were reviewed. Twelve articles were excluded because they were not randomized controlled trials or were repeat publication. Finally, six trials3, 4, 9, 10, 11, 12 including 853 patients were included in this meta-analysis. The main features of the six trials are shown in Table 1.

Primary Outcomes

In this report, we considered biopsy-proven rejection,

Discussion

Induction therapy is specific therapy given at the time of transplantation to lower the incidence of acute rejection and thus improve allograft survival. Some agents, such as ATG/ALG, OKT3, daclizumab, basiliximab, and Alemtuzumab have been tried in clinical induction therapy.1, 4, 13 Among them, ATG and basiliximab are most widely used. Currently, almost 70% of kidney transplant recipients receive induction therapy with either basiliximab or ATG.14 Many studies and meta-analysis demonstrated a

References (14)

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  • Effectiveness of Thymoglobulin Induction Therapy in Kidney Transplant From Deceased Donor With Mild to Moderate Acute Kidney Injury

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    Basiliximab and Thymoglobulin are the most commonly used agents for induction therapy of KT, and there have been many comparative studies on their efficacy and safety. There was no significant difference in efficacy between the 2 groups in the general randomized controlled trials, but Thymoglobulin was better in acute rejection in study of high-risk patients [12–16]. It is now common practice in the transplant community to select induction therapy on the basis of risk-benefit consideration.

  • Immunosuppressive Therapy in Transplantation

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    Even though induction therapy provides clear improvement in patient and graft outcomes, infection and malignancy, particularly cytomegalovirus and lymphoma respectively, remain major concerns following administration of induction therapy.6,13,14,19,21 Basiliximab seems to result in fewer infections compared with other agents.5 Further data are needed to determine whether basiliximab is superior to R-ATG in the reduced incidence of neoplasm.

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This work is attributed to the Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Ministry of Health, and Key Laboratory of Ministry of Education.

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